Executive Skills in Children and Adolescents The Guilford Practical Intervention in the Schools Series Kenneth W. Merrell, Series Editor This series presents the most reader-friendly resources available in key areas of evidence-based practice in school settings. Practitioners will find trustworthy guides on effective behavioral, mental health, and academic interventions, and assessment and measurement approaches. Covering all aspects of planning, implementing, and evaluating high-quality services for students, books in the series are carefully crafted for everyday utility. Features include ready-to-use reproducibles, lay-flat binding to facilitate photocopying, appealing visual ele- ments, and an oversized format. Recent Volumes School-Based Behavioral Assessment: Informing Intervention and Instruction Sandra Chafouleas, T. Chris Riley-Tillman, and George Sugai Collaborating with Parents for Early School Success: The Achieving–Behaving–Caring Program Stephanie H. McConaughy, Pam Kay, Julie A. Welkowitz, Kim Hewitt, and Martha D. Fitzgerald Helping Students Overcome Depression and Anxiety, Second Edition: A Practical Guide Kenneth W. Merrell Inclusive Assessment and Accountability: A Guide to Accommodations for Students with Diverse Needs Sara E. Bolt and Andrew T. Roach Bullying Prevention and Intervention: Realistic Strategies for Schools Susan M. Swearer, Dorothy L. Espelage, and Scott A. Napolitano Conducting School-Based Functional Behavioral Assessments, Second Edition: A Practitioner’s Guide Mark W. Steege and T. Steuart Watson Evaluating Educational Interventions: Single-Case Design for Measuring Response to Intervention T. Chris Riley-Tillman and Matthew K. Burns Collaborative Home/School Interventions: Evidence-Based Solutions for Emotional, Behavioral, and Academic Problems Gretchen Gimpel Peacock and Brent R. Collett Social and Emotional Learning in the Classroom: Promoting Mental Health and Academic Success Kenneth W. Merrell and Barbara A. Gueldner Executive Skills in Children and Adolescents, Second Edition: A Practical Guide to Assessment and Intervention Peg Dawson and Richard Guare Responding to Problem Behavior in Schools, Second Edition: The Behavior Education Program Deanne A. Crone, Leanne S. Hawken, and Robert H. Horner High-Functioning Autism/Asperger Syndrome in Schools: Assessment and Intervention Frank J. Sansosti, Kelly A. Powell-Smith, and Richard J. Cowan School Discipline and Self-Discipline: A Practical Guide to Promoting Prosocial Behavior George G. Bear Executive Skills in Children and Adolescents A Practical Guide to Assessment and Intervention SECond EdITIon PEg DaWSon RichaRD guaRE ThE guiLFoRD PRESS New York London © 2010 The Guilford Press A Division of Guilford Publications, Inc. 72 Spring Street, New York, NY 10012 www.guilford.com All rights reserved Except as indicated, no part of this book may be reproduced, translated, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher. Printed in the United States of America This book is printed on acid-free paper. Last digit is print number: 9 8 7 6 5 4 3 2 1 LIMITED PHOTOCOPY LICENSE These materials are intended for use only by qualified professionals. The Publisher grants to individual purchasers of this book nonassignable permission to reproduce all materials for which photocopying permission is specifically granted in a footnote. This license is limited to you, the individual purchaser, for personal use or use with individual clients or students. This license does not grant the right to reproduce these materials for resale, redistribution, electronic display, or any other purposes (including but not limited to books, pamphlets, articles, video- or audiotapes, blogs, file-sharing sites, Internet or intranet sites, and handouts or slides for lectures, workshops, webinars, or therapy groups, whether or not a fee is charged). Permission to reproduce these materials for these and any other purposes must be obtained in writing from the Permissions Department of Guilford Publications. Library of Congress Cataloging-in-Publication Data Dawson, Peg. Executive skills in children and adolescents : a practical guide to assessment and intervention / Peg Dawson and Richard Guare. — 2nd ed. p. cm. — (The Guilford practical intervention in the schools series) Includes bibliographical references and index. ISBN 978-1-60623-571-3 (pbk.: alk. paper) 1. Executive ability in children. 2. Executive ability in adolescence. 3. Self-management (Psychology) for teenagers. 4. Self-management (Psychology) for children. I. Guare, Richard. II. Title. BF723.E93D39 2010 155.4′13—dc22 2009049722 About the Authors Peg Dawson, EdD, is a staff psychologist at the Center for Learning and Attention Disor- ders at Seacoast Mental Health Center in Portsmouth, New Hampshire, where she special- izes in the assessment of children and adults with learning and attention disorders. She received her doctorate in school/child clinical psychology from the University of Virginia and has worked as a school psychologist in Maine and New Hampshire. Dr. Dawson has many years of organizational experience at the state, national, and international level and has served in many capacities, including President, of the New Hampshire Association of School Psychologists, the National Association of School Psychologists (NASP), and the International School Psychology Association. She is the 2006 recipient of NASP’s Lifetime Achievement Award. Dr. Dawson and her colleague Richard Guare have written a manual on coaching students with attention disorders and are the authors of Smart but Scattered: The Revolutionary “Executive Skills” Approach to Helping Kids Reach Their Potential, a book for parents on helping children develop executive skills. Richard Guare, PhD, is a neuropsychologist and board- certified behavior analyst who serves as director of the Center for Learning and Attention Disorders at Seacoast Mental Health Center. He received his doctorate in school/child clinical psychology from the Uni- versity of Virginia and completed a postdoctoral fellowship in neuropsychology at Children’s Hospital Boston. Dr. Guare serves as a consultant to schools and agencies in programs for autism, learning and behavior disorders, and acquired brain injuries. He has presented and published research and clinical work involving attention, executive skills, and neurological disorders. Dr. Guare is coauthor with Peg Dawson of the book Smart but Scattered and of a manual on coaching students with attention disorders. He is also coauthor, with Chuck Martin and Peg Dawson, of two books on executive skills of adults in business settings. v Preface When we published the first edition of Executive Skills in Children and Adolescents in 2004, executive skills was a relatively new and unfamiliar concept to school psychologists and educators. In the intervening years, the research base has expanded beyond a focus on populations with impairments, such as head injury, to address typical brain development, and the term has become more familiar to parents and teachers alike as they work to under- stand why some children struggle in school in the absence of an obvious learning disabil- ity or emotional disorder. Furthermore, the way schools provide services to students with learning impairments has shifted from a “discrepancy model” to a response-to- intervention (RTI) model along with an emphasis on evidence-based practice. These changes in the field have created a need for a revised and expanded edition of our book. Executive function is a neuropsychological concept referring to the high-level cognitive processes required to plan and direct activities, including task initiation and follow- through, working memory, sustained attention, performance monitoring, inhibition of impulses, and goal- directed persistence. While the groundwork for development of these executive skills starts before birth, they develop gradually and in a clear progression through the first two decades of life. From the moment that children begin to interact with their environment, adults have expectations for how they will use executive skills to negotiate many of the demands of childhood—from the self- regulation of behavior required to act responsibly to the planning and initiation skills required to complete chores and homework. Parents and teachers expect children to use executive skills even though they may understand little about what these skills are and how they impact behavior and school performance. Our first encounter with executive skills came through our work with children and teenagers who had sustained traumatic brain injuries. Problems involving planning and organization, time management, and memory, as well as weaknesses with inhibition and regulation of emotions, have long described a significant component of traumatic brain injury. Executive skills have also assumed an increasingly important role in the explana- tion of attention- deficit/hyperactivity disorder (ADHD). While we were introduced to these vii viii Preface skills originally in our work with these populations, we have seen an increasing number of youngsters who seem to struggle in school because of weaknesses in executive skills even when they do not meet the diagnostic criteria for ADHD or another disorder. We believe that these students will benefit from interventions designed to improve executive function- ing. To do so, however, requires an understanding of what executive skills are, how they develop in children, and how they impact school performance. This book is intended to shed light on these important cognitive processes so that parents and teachers can better help children hone these skills for the purpose of achieving long-term independence—the ultimate desirable outcome of childhood. Following the publication of the first edition of this book, we heard from school psy- chologists and special educators, who found the book invaluable for their daily practice. We also heard from clinical psychologists, neuropsychologists, and pediatric specialists from the medical profession that the book was a useful tool for them in their daily work with children whose problems ranged from the relatively mild issues associated with normal growth and development to the more severe impairments associated with acquired brain injuries, neurological disorders, autism, and ADHD. And, finally, we heard from enough parents who found the book helpful that we were compelled to write a book specifically for them, called Smart but Scattered: The Revolutionary “Executive Skills” Approach to Help- ing Kids Reach Their Potential (Dawson & Guare, 2009). We continue to work with students with executive skill weaknesses both in our clinic setting and in the schools in which we consult. And we continue to refine our understand- ing of how executive skills affect learning and how parents, teachers, and psychologists can intervene effectively. The second edition of this book reflects our evolving understanding of the role executive skills play in academic and social success. ovErvIEw of ConTEnTS Chapter 1 defines what we mean by executive skills and lists 11 separate skills included in the construct of executive functioning. This chapter also describes how these skills develop from infancy through adulthood and lists the kinds of developmental tasks for which execu- tive skills are required and the ages at which we expect children to perform such tasks. Chapter 2 describes the variety of techniques that can be employed to assess executive functioning in children and adolescents, including the use of clinical interviews, behavior rating scales, behavioral observations, and formal test instruments. This chapter features a table that summarizes how each executive skill may appear in testing situations, how it might be displayed on specific tests or subtests, what rating scales may capture the skill, and what it looks like in activities of daily living at home and at school. Chapter 3 outlines a process for linking assessment to intervention, beginning with the identification of specific skill weaknesses and their behavioral manifestations and leading to the development of multimodal intervention strategies based on the behaviors of concern. It offers sample behavioral objectives developed for each executive skill and a case study illustrating how the assessment process is linked to intervention design. The chapter con- cludes with an introduction to RTI and how executive skills weaknesses in students can be addressed within a three- tiered model of service delivery. Preface ix Chapter 4 broadly overviews intervention strategies that support students with weak executive skills as well as foster the development of more effective skills. Whereas the first edition of this book focused on interventions designed for individual children, we have expanded this chapter to include a discussion of whole-class interventions and of teaching strategies beyond those that address behavioral deficits (such as forgetting to bring home homework assignments at the end of the school day) to include routines to address behav- ioral excesses, such as poor impulse and emotional control. We also introduce the concept of “scripts” (i.e., self-talk), which has emerged as a promising strategy for improving self- regulation. Chapter 5 delineates an array of teaching routines that can be used in the classroom either with individual students or whole classes to target common problems associated with weak executive skills. We list the set of steps to follow in teaching the routine, then briefly discuss how the routine can be modified for whole-class use at both the elementary and secondary levels. Chapter 6 addresses each of the 11 executive functions in turn. We focus both on envi- ronmental modifications that can be used to support students with executive skills weak- nesses and on strategies for teaching the skill so that students can function independently with respect to the skill in question. Each skill concludes with a vignette that shows how the strategies play out in real-life situations, and a set of “Keys to Success” that reiterate critical aspects of the intervention design that increase the likelihood of improving performance. Chapter 7 delves into a description of “coaching,” an umbrella strategy that we believe has wide application for helping students acquire executive skills. Expanded from the first edition, the chapter includes an overview of research supporting the efficacy of coaching and coaching applications, including peer coaching and group coaching. Chapter 8 returns to a discussion of executive skills within an RTI model. Whereas Chapter 3 focused on the assessment side of the model, this chapter illuminates the inter- vention side. Features include a checklist of classroom supports that should be present at Tier 1 (universal level) intervention and a table that lists environmental modifications, instructional supports, and motivational strategies applicable at each of the three tiers. It concludes with a case study of how the RTI process might work with a student with execu- tive skills weaknesses. Chapter 9 examines executive skills as they may appear in special populations such as children with acquired brain injury, ADHD, and autism spectrum disorders, and we proffer some guidance on how to approach complicated cases, for example, students with multiple learning or behavior problems. Finally, Chapter 10 proposes ways to handle students with executive skills weaknesses during times of transition. In our work with students, families, and schools, we have found that students are most at risk for regression or failure when they move from grade to grade or from school to school. We offer some suggestions to schools about how to manage these transitions with the hope that all the hard work and success achieved in one school or grade level is not undone in the next.